Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Form and Function Physical Therapy PLLC

Organization Physical Therapy Clinic/Center · NPI 1578265476

Form and Function Physical Therapy PLLC is a Physical Therapy Clinic/Center in Glen Allen, Virginia. Registered with an NPI since 2023.

In the registry since
2023
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

11411 Hunton Cottage Ct
Glen Allen, VA 23059-4848
Phone: (804) 564-5194
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Clinic/Center (primary) Taxonomy 261QP2000X

Record details

NPI number1578265476
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Pratik Shah — Ceo · (804) 564-5194
NPI enumeratedMarch 22, 2023
Last updated in NPPESMarch 28, 2023
Certification dateMarch 28, 2023
Mailing address11411 Hunton Cottage Ct, Glen Allen, VA 23059-4848

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